title: Treatment of cerebral radiation necrosis with bevacizumab: the Cleveland clinic experience.
abstract: BACKGROUND
  Cerebral radiation necrosis (RN) is a devastating complication of radiation therapy for brain tumors. Recent studies have explored the role of bevacizumab, a humanized monoclonal antibody directed against vascular endothelial growth factor in the treatment of RN of the brain. We report 24 patients with cerebral RN who were treated with bevacizumab.
  
  
  METHODS
  Twenty-four patients diagnosed with cerebral RN and treated with different schedules of bevacizumab between July 2007 and June 2012, were identified from the Cleveland Clinic Brain Tumor and Neuro-Oncology Center's database. Pretreatment and posttreatment magnetic resonance imaging (MRI) studies were compared to evaluate bevacizumab efficacy.
  
  
  RESULTS
  Posttreatment MRI demonstrated a radiographic improvement in 23 of 24 patients on the postcontrast T1-weighted MRI and fluid-attenuated inversion-recovery sequences. Using the McDonald criteria, the average change in the T1-weighted postcontrast MRI was a decrease of 48.1%, and the average change in the fluid-attenuated inversion-recovery images was a decrease of 53.7%. There was a mean daily dose reduction of 9.4 mg of dexamethasone after initiation of bevacizumab in patients who were on steroids at the start of bevaciuzmab therapy for RN. Treatment with bevacizumab was well tolerated with only 1 grade 3 adverse event.
  
  
  CONCLUSIONS
  The current study demonstrates that bevacizumab treatment results in excellent clinical and radiologic response in patients with RN caused by common forms of radiation therapy. The safety profile of bevacizumab use in RN is acceptable. In the current study, we found no difference between different schedules of bevacizumab in treatment outcomes.
authors.affiliation: *Cleveland Clinic Lerner College of Medicine, Rose Ella Burkhardt Brain Tumor Neuro-Oncology Center, Neurological Institute †Radiation Oncology ‡Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Neda H
authors.initials: NH
authors.lastname: Sadraei
authors.forename: Saurabh
authors.initials: S
authors.lastname: Dahiya
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Chao
authors.forename: Erin S
authors.initials: ES
authors.lastname: Murphy
authors.forename: Kwabena
authors.initials: K
authors.lastname: Osei-Boateng
authors.forename: Hao
authors.initials: H
authors.lastname: Xie
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
authors.forename: David M
authors.initials: DM
authors.lastname: Peereboom
authors.forename: Glen H J
authors.initials: GH
authors.lastname: Stevens
authors.forename: Manmeet S
authors.initials: MS
authors.lastname: Ahluwalia
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000532:radiotherapy*; D054022:Cerebrum / Q000473:pathology / Q000528:radiation effects*; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000188:drug therapy / Q000209:etiology; D011832:Radiation Injuries / Q000188:drug therapy* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects
chemical_list: D020533:Angiogenesis Inhibitors; D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D003907:Dexamethasone